HSCG44-16-R-N0019_-_Attachment_(6)_-_Past_Performance_Questionnaire.pdf

HSCG44-16-Q-N0019

Attachment 6

DEPARTMENT OF HOMELAND SECURITY

U.S. COAST GUARD

COMMAND, CONTROL, AND COMMUNICATIONS ENGINEERING CENTER (C3CEN)

COMMAND, CONTROL, COMMUNICATIONS, COMPUTERS AND INFORMATION

TECHNOLOGY SERVICE CENTER (C4IT-SC)

4000 COAST GUARD BOULEVARD

PORTSMOUTH, VA 23703

SOLICITATION: HSCG44-16-Q-N0019

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

In order to assess potential vendors, the C4IT-SC contracting office is obtaining past performance information with respect to each offeror. This PPQ must be completed by the Past Performance

Reference, NOT the Offeror, and submitted directly to the Contracting Officer by the Past Performance

Reference. The completed PPQ shall not be released to the offeror. In addition to this questionnaire, you may receive a follow-up phone call to confirm or clarify information. We are thanking you in advance for your time, effort, and cooperation in responding to this questionnaire. Please submit the completed form to Stephen A. Clark, Contracting Officer via email at Stephen.A.Clark@uscg.mil. Please contact

Mr. Clark at (757) 295-2278 if you have any questions. The completed PPQ is due on or before June 2, 2016 at 10:00 AM, EST.

I. GENERAL GUIDANCE

Please use the following rating in scoring the performance elements below (assessments should reflect only contractor-liable performance):

RATING DESCRIPTION

Exceeds The Contractor's past performance far exceeds the customer's expectations and provided significant, unusual worthwhile features or benefits.

Satisfactory The Contractor's past performance met the customer's expectations and contract requirements

Marginal The Contractor's past performance could have been improved. The Contractor required major agency resources to ensure achievement of contract requirements.

Unsatisfactory The Contractor's past performance did not meet customer expectations and/or contract requirements.

II. GENERAL INFORMATION

A. AGENCY & RESPONDENT IDENTIFICATION:

1 Name:

2 Title:

3 Organization:

4 Address:

5 Phone Number:

mailto:Stephen.A.Clark@uscg.mil

6 Fax Number:

7 E-mail Address:

8 Date:

9 Signature:

B. CONTRACT IDENTIFICATION:

1 Name of Contractor:

Type of Instrument

(e.g. Contract/BPA/Order/Other):

2 Contract Identification Number:

3 Order Number (If applicable):

4 Project Title and Service Description (Add rows if needed):

Type of Contract

(e.g. Negotiated, Sealed Bid):

Pricing Type (e.g. Fixed Price, T&M, Cost Reimbursement, other):

7 Date of Award:

8 Contract Dollar Value/Ceiling:

9 Period of Performance:

10 Place(s) of Performance:

C. GENERAL INFORMATION

Has this Contractor ever failed to provide services required by the contract? If yes, explain.

III. EVALUATION: How Would You Rate This Contractor With Respect To:

A. Compliance with the SOW and specifications; conformance to standards of good workmanship, and responsiveness to technical direction:

Rating Exceeds Satisfactory Marginal Unsatisfactory

Check

Summary:

B. Adherence to the contract delivery schedule:

C. Working relationship with Contracting Officer, COR, and other points of contact:

In summary, please give your overall assessment of this contractor.

Do you have additional comments to add?